Anorexia Nervosa

What is beauty or
attractiveness to you?
Researchers that relate size and shape of women
to their physical attractiveness use BMI & WHR

 BMI: Standard measure of weight, calculated by

dividing weight in kilograms by height in meters
squared.
 BMI’s below 18.5 are considered underweight.
 BMI’s from 18.5 to 25 are normal weight
 BMI’s from 25 to 30 overweight
 BMI’s over 30 are obese
WHR: Waist-to-hip Ratio
 WHR is calculated by dividing waist
circumference by hip circumference
 Young adult women fall in the .70 to .90
range.
 Adult men fall in the range of .80 to .95
Differences in waist to hip ratio
 They are usually due to hormonal
differences, with circulating ESTROGEN
causing fat cells accumulation of in the hip
region and inhibiting fat accumulation in
the waist region!
 Testosterone causes accumulation of fat
cells around the waist and inhibits fat
deposits in the hip region.
Differences in female and male
shape

 AHA!! It’s largely due to the difference of

estrogen and testosterone in our bodies!
They allow each sex to carry their weight
in different places.
Women’s Ideals
 In this research the ideal was 20.3, which
is at the low end of normal.
 In self ratings overweight BMI rated
themselves as least attractive, while
women who were underweight rated
themselves as most attractive.
Men are more likely to participate in
binge eating and purging than women.
The binge eating is societally more
accepted for men than women.

Men’s body concerns are different than

women’s. Women often wanting
thinness or leanness. While men want
muscularity for their bodies.
being attractive, no wonder we have a
drive to be thin!
Our society believes “ THIN IS IN”

“Results in increased social pressure to

be thin and body dissatisfaction, which
putatively lead to dieting, negative
affect, and consequent increased risk
for eating pathology”
The drive to being thin comes
from a variety of areas in both
women and men’s lives. The
need to be a society’s ideal is
so strong, that people often
develop eating disorders.
-Anorexia Nervosa
-Bulemia
Anorexia Nervosa
 Weight: 15 % below ideal body weight.
Refusal to maintain a normal weight or
above normal weight for height and age.
Not everyone who is of a low weight is
anorexic; it is important to recognize that it
is the REFUSAL to maintain a normal
weight that is the key factor.
 Self –evaluation quiz for Anorexia

 Are you constantly thinking about your weight and food?

 Are you dieting strictly and/or have you lost a lot of
weight?
 Are you more than 10% below your healthy weight?
 Are people concerned about your weight?
 Is your energy level down?
 Do you constantly feel cold?
Types of Anorexia

 Many individuals with anorexia will severely restrict their calories

sometimes taking in only a few hundred calories a day or just water.
This is called the RESTRICTING TYPE. Our bodies do not like to
starve. Remember, the individual with anorexia has an appetite they
just try to control it. It is very difficult when you are starving not to
want to eat. What happens to many as a result is that they lose
control they eat or eat something they feel they should not have
eaten. For these individuals, this might mean something as simple
as a cookie, a normal meal or even a binge. With the fear of gaining
weight, they may vomit or exercise. This type of anorexia is called
the BINGE-EATING/PURGING TYPE one of the most dangerous
forms of an eating disorder
Symptoms of Anorexia
 ANOREXIA NERVOSA
 • Deliberate self-starvation with weight loss
• Intense, persistent fear of gaining weight
• Refusal to eat or highly restrictive eating
• Continuous dieting
• Excessive facial/body hair because of inadequate
protein in the diet
• Compulsive exercise
• Abnormal weight loss
• Sensitive to cold
• Absent or irregular menstruation
• Hair loss
PHYSICAL REPERCUSSIONS
FROM ONE OR BOTH DISEASES

• Malnutrition 
• Dehydration
• Ruptured stomach
• Serious heart, kidney, and liver
damage
• Tooth/gum erosion
• Tears of the esophagus 
PSYCHOLOGICAL
REPERCUSSIONS FROM BOTH
DISEASES
• Depression
• Low self-esteem
• Shame and guilt
• Impaired family and social
relationships
• Mood swings
• Perfectionism
Are you overeating and feeling out of
control?
Are you vomiting, using laxatives or water
pills, herbal agents, or trying to fast as a way
to control your weight?
Are you over exercising or do others
consider your excercise excessive ?
Does your weight drastically fluctuate?
Do any of the above interfere with your
enjoyment of life, relationships, or everyday
functioning?
Figures on Anorexia
 AGE AT ONSET OF ILLNESS:
•86% report onset of illness by the age of 20*
•10% report onset at 10 years or younger
•33% report onset between ages of 11-15
•43% report onset between ages of 16-20
DURATION OF ILLNESS/MORTALITY:
•77% report duration from one to fifteen years*
•30% report duration from one to five years
•31% report duration from six to ten years
•16% report duration from eleven to fifteen years
•It is estimated that six percent of serious cases die
•Only 50% report being cured 
 Death rates of Anorexia

 Young women that have anorexia nervosa

are 12 times more likely to die other
women her age without anorexia. Anorexia
has the highest mortality rate of all mental
disorders. The mortality rate is about 5%
for each decade and increases up to 20%
for patients that have the illness for more
than 20 yrs.
Anorexia effects the body in a
variety of ways. . There are
problems associated with mental
functioning, the heart, esophagus,
stomach, intestines, mouth, and
endocrine system.
Psychological Problems Associated
with Anorexia
 -Feeling dull
-Feeling Listless
-Difficulty concentrating or focusing
-Difficulty regulating mood
-Associated mental disorders: depression,
anxiety disorders, obsessive-compulsive
disorder, substance abuse
Medical Issues
 Cardiovascular (Heart):
 -Slow irregular, pulse
-Low blood pressure
-Dizziness or faintness
-Shortness of breath
-Chest pain
-Decreased potassium levels may result in life threatening cardiac
arrhythmias or arrest
-Electrolyte imbalances may lead to life threatening cardiac arrhythmias
or arrest
 Muscular Skeletal (Bones):
-Stunted growth in children
-Stress fractures and broken bones more likely
-Osteoporosis
More Medical Issues
 Mouth:
 -Enamel erosion
-Loss of teeth
-Gum disease
-“Chipmunk cheeks”- swollen salivary glands from vomiting
-Sore throat because of induced vomiting
 Esophagus:
 -Painful burning in throat or chest
-May vomit blood from small tear(s) in esophagus
-Rupture of the esophagus, may lead to circulatory collapse and death 
 Endocrine System:
 -Thyroid abnormalities
-Low energy or fatigue
-Cold intolerance
-Low body temperature
-Hair becomes thin and may fall out
-Development of fine body hair as the body’s attempt to keep warm
Yet Even More Medical Issues
 Stomach:
 -Stomach may swell following eating or binging (causes discomfort
and bloating)
-Gastric rupture due to severe binge eating (gastric rupture has an
80% fatality rate)
-Vomiting causes severe electrolyte imbalance which can lead to
sudden cardiac arrest.
 Intestines:
 -Normal movement in intestinal tract often slows down with very
restricted eating and severe weight loss
-Frequent Constipation
-Chronic irregular bowel movements
Study done testing the motor
functions in rats with DR( Dietary
Restrictions)
 Rats had a lower level of accuracy while
on a restricted caloric diet
 During DR animals became frantic and
made repeated attempts to grasp a single
pellet.
Other Problems
 DR may also disrupt reproductive
cycles in both male and female rats,
often causing delayed onset of
puberty and decrease in fertility.
 Could this be for humans too? Yes!
 Yet more problems
 Negative effects of DR are sometimes
more apparent in younger animals.
 Food is scarce or severely restricted,
reproductive performance, growth, and
immune responces are sacrificed
 Leaves animals prone to infection,
reduced growth, hormonal imbalances, or
permanent neurological deficit.
 Both in humans and rats
 Dietary restrictions often lead to
preoccupation with food, irritability, and
overeating upon presentation of food
 In anorexia, there is often a preoccupation
of thinking about food, and their episodes
of purging.
 Food restrictions acts a cellular stressor to
metabolic substrate deprivation
 Increase in levels of plasma corticosterone
 Increase in adrenal gland weight
 Decrease in glutocotropin receptors
 Increase of responcivity to stress inducing
procedures
Why all of this?
 It has been suggested that behavioral
alterations during DR are due to
hypothalmic-pituitary-adrenal axis and
changes in level of stress hormone.
 Fewer and shorter synapses in
sensorimotor cortex.
Therapy
 There are over 400 schools of psychotherapy, each
claiming a distinct theory and set of treatment technique.
Psychodynamic and cognitive-behavioral therapies
probably represent the most widely used.
 There is no one definitive form of therapy recommended
for eating disorders. Often the therapist will evaluate
where the patient is. For some individuals, they may be
very knowledgeable and have had experience with some
intervention. For others, it is a totally new experience
 Resources
  Moradi B, Dirks D, Matteson AV. Roles of sexual
objectification experiences and internalization of
standards of beauty in eating disorder symptomatology: A
test and extension of objectification theory. Journal of
Counseling Psychology. 2005; 52(3):420-428
  Ricciardelli LA, McCabe MP, Holt KE, Finemore J. A
biopsychosocial model for understanding body image and
body change strategies among children. Journal of
Applied Developmental Psychology. 2003; 24(4):475-495.
Continuation of Resources

Smith LK, Metz GA. Dietary restriction alters fine

motor function in rats. Physiol Behav. 2005;
85(5):581-592
Weeden J, Sabini J. Physical attractiveness and
health in western societies: A review. Psychol
Bull. 2005; 131(5):635-653
http://www.anad.org/site/anadweb/
National Association of Anorexia Nervosa and
Other Associated Disorders